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I wish I could respond to the letter of Jack S. Moskowitz, DO, by reporting that the American Osteopathic Association (AOA) and the osteopathic medical profession have supported the pathology specialty in the past and have demonstrated that they will support the pathology specialty in the future. Unfortunately, osteopathic pathology has historically been a “stepchild” of osteopathic medicine.

There have always been few residency programs in pathology approved by the AOA, and after the 1999-2000 academic year—as a result of several factors—the last AOA-approved residency program in pathology closed.1

From my experience as a pathology program director and from my conversations with other program directors, I know that factors contributing to the closing of these residency programs included removal of funding for these programs by their associated osteopathic hospitals and colleges of osteopathic medicine; decreases in federal funding for residencies in general; and a marked decrease in interest by osteopathic medical students in seeking osteopathic pathology residencies.

The reality is that program slots accredited by the Accreditation Council for Graduate Medical Education (ACGME) have always been numerous and available to osteopathic medical students. As a consequence, our students preferentially gravitated to those programs instead of the AOA-approved programs—when available.2 In addition, the AOA-approved pathology residency programs were most often located in small community hospitals. What osteopathic medical student would want to go into that sort of program when he or she could be in a large university program and obtain a higher-quality education?

In regard to professional support for osteopathic pathologists after they complete their ACGME-accredited residency programs, there is a pathway for AOA board certification of the anatomic pathology specialty.3,4 However, the AOA has made it extremely difficult for pathology residents who train in ACGME-accredited programs to obtain osteopathic certification. The AOA still mandates that pathology residents take an AOA-approved clinical/rotating/transitional internship before beginning their ACGME-accredited pathology residency.5 This mandate may not have mattered much several years ago, when the American Board of Pathology (ABP) also required a clinical year for residents in ACGME-accredited programs. However, now that the ABP has decreased the term of residency from 5 years to 4 years,6 few osteopathic medical students are willing to take that AOA-required transitional internship and incur additional debt during their residency years.

As the chair of the American Osteopathic Board of Pathology (AOBP) and as a former president of the American Osteopathic College of Pathologists (AOCP), I have witnessed declining numbers of DO pathologists seeking certification from the AOBP and declining membership in the AOCP. These declines have resulted in financial problems for the AOBP. However, our board is currently approaching all of the program directors of ACGME-accredited pathology residencies to let them know about the certification available from the AOBP, and we are asking them to inform the DOs in their programs about the AOBP option for certification. Furthermore, the AOBP is currently working with the AOA, the AOCP, and the Bureau of Osteopathic Specialists to try to at least streamline the process of getting ACGME-accredited pathology residency programs approved for those DO pathology residents who wish to pursue osteopathic certification.

I can only hope that residents such as Dr Moskowitz decide to seek osteopathic certification and come to work with the AOBP in revitalizing the osteopathic medical profession.